This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Thursday, January 22, 2015

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot. Indeed more than a few commentators are now wondering out loud if the Abbot Government will last for a second term.

This article from the last weekend seems to reveal the level of chaos in the Government internally.

LIBERAL MPs are emerging from their summer holidays with sand in their toes and something that rhymes with twit on their liver.

After spending a record twenty weeks last year floating in the Canberra bubble, Tony Abbott’s troops have returned to their electorates. Shortly, MPs will return to the mothership with news from abroad. The news is not good. The natives are restive rather than rested.

Demoralised MPs have been lovingly dipping into the pages of John Howard’s biography Lazarus Rising over summer.

Chapter 27, The Holy Grail of Tax Reform, is getting quite a workout. “As 1997 progressed, it became clear for a number of reasons that the Government, for a variety of reasons, had lost momentum,’’ Howard writes.

“I did not need a lot of persuading that the Government had to maintain the momentum of reform otherwise the public would become restless.’’

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The modified Medicare co-payment - announced late last year - seems to have annoyed most other than the Government and we now wait till mid February 2015 to see what the Senate thinks of Plan B.

Now part of Plan B are gone but some extreme nasties still remain. While the rebate cut for short consults has been abandoned the freezing of rebate levels until 2018 and a plan for a co-payment are still live

General Budget Issues.

Tony Abbott tells us that 2015 will be the year of jobs and families. Well, he wishes. It may yet come to pass, but if it does it will have to be in the second half of the year – if at all.

First, of course, we have to get rid of the Queensland election, and almost as soon as the dust settles it will be time to start working in New South Wales. The conservatives should win in both states, but it will not be without pain, and certainly not without controversy: Labor will certainly make up ground, and in the post mortems Abbott’s own role will be a major part of the debate.

And this will be whether he takes part in one or other of the campaigns, or if he is told by the respective premiers to butt out. Shorten is making hay in the issue in the sunshine state while Warren Truss is showing the flag as acting prime minister and demonstrating just how acting he is.

The move comes as the government considers stripping the private health insurance rebate from any policies covering natural therapies not supported by evidence.

As well as deregulating university fees and cutting university funding, the government's higher education reforms would extend funding to private colleges, TAFEs and sub-bachelor degree programs at a cost of $820 million over three years.

TEN per cent of all health expenditure — as much as $15 billion a year — could be saved through a concerted effort to reduce wasteful programs, marginal treatments and avoidable errors, senior officials in the Department of Health have revealed.

The department’s Strategic Policy Group was examining large-scale savings — including an evidence-based campaign of “disinvestment” in low-value programs, drugs and therapies — long before the Abbott government committed to its unpopular GP co-payment.

Documents obtained by The Australian under Freedom of Information laws show the group of deputy secretaries and other officials wanted to reduce spending on low-value interventions and get serious about combating avoidable side-effects, mistakes and infections.

Health and Indigenous Affairs Correspondent

The number of high-priced drugs being subsidised by the Commonwealth has dramatically increased in recent years as pharmaceutical companies produce more targeted therapies for smaller groups of patients.

According to the federal Health Department, there are 61 drugs listed on the Pharmaceutical Benefits Scheme that cost more than $5000 each time they are dispensed.

In 1991, $2800 would have had the same buying power as $5000 today. Yet the most expensive drug listed on the scheme in 1991 cost $843 – less than a third of this amount.

In response to a question from Liberal senator Linda Reynolds, the department said while there were a similar number of drugs costing $20 or less in 1991 and 2014, "the number of higher cost listings has grown significantly".

More than 500 drugs are currently listed on the PBS with a cost of between $1001 and $5000.

THE greater risk of disease and death if you are poor or unemployed in Australia was spelled out in detail by health officials in a paper prepared five months ago — ostensibly for then health minister Peter Dutton.

While the Abbott government has largely ignored a global push for policies to address the so-called social determinants of health, those issues were being discussed in-depth by the Health Department as early as August last year.

According to documents ­obtained under Freedom of Information laws, assistant secretary David Cullen briefed one meeting on a “preliminary research paper produced by the Strategic Policy Unit at the request of the Secretary and Minister Dutton on socio-economic gradients in health”.

The paper showed how morbidity, or disease, occurs more often in: poor households (the rate in the poorest households is 2.6 times the rate in the richest); communities with no education (the rate in the least educated communities is 1.2 times the rate in the most educated); unemployed groups (the rate for those out of the labour force is 3.1 times that of those who have jobs); remote areas (the rate in remote and very remote Australia is 1.4 times the rate of those living in major cities); and among indigenous Australians (3.7 times the rate of kidney disease, 3.3 times the rate of diabetes).

AT the end of last year I went to see my GP. I think I should have paid him double because I spent quite some time picking his brains about the government’s proposed changes to GP payments, both versions. The first was announced in May last year and the second in December.

The practice I attend has a mix of payment arrangements. For those with concession cards, children and for rapid return visits (to check on test results, for example), the doctors have taken the decision to bulk-bill. For other patients, the standard fee is $70, with just over $37 reimbursed by Medicare. I personally think that’s just fine.

My well-intentioned doctor conceded that Mark II of the policy was slightly better than Mark I, but he still had concerns. Having looked into the details, I share his disquiet. The changes have not been properly considered. They are a classic case of the tail wagging the dog given the requirement that the large dollar figure in savings announced in the budget (about $3.5 billion) must be retained.

The announcement by Health Minister Sussan Ley that she has abandoned the planned Medicare rebate cut, flagged by her predecessor Peter Dutton, and is going to “pause, listen and consult” with the health sector and cross-benchers makes both political and policy sense.

The rebate cut was unlikely to pass the Senate and had been widely criticised by a broad spectrum of health groups, damaging the Government’s relationship with the sector. Ley’s move gives the Government the opportunity to re-group and re-think its approach to health financing and to repair its relationship with key health groups before the next federal election.

Despite claims by the Government that its plans to cut Medicare rebates and introduce co-payments are the only options being put forward to meet the challenge of rising health care costs, there are a wealth of other ideas being proposed to improve the way in which we manage our health budget (some of which have been suggested by the Government’s own Department).

One of the most recent contributions to this debate is a new paper by Dr Lesley Russell, from the Menzies Centre for Health Policy at the University of Sydney and myself. This paper outlines some of the key health funding challenges facing our health system and proposes some alternatives to rebate cuts and co-payments to improve the management of health expenditure and rising out-of-pocket health care costs. The paper is intended to prompt further discussion on these important issues for the future of our health system, rather than provide definitive solutions.

Health and Indigenous Affairs Correspondent

The Australian Medical Association predicts many doctors will be caught out by a change quietly made by the Abbott government two days before Christmas which will cut the Medicare rebates which apply for short consultations for one class of doctors.

AMA president Brian Owler said the last-minute change, which will take effect on January 19, is proof that the government's second attempt at overhauling Medicare was "rushed" and "poorly thought out".

On December 9, Prime Minister Tony Abbott and then-health minister Peter Dutton announced the government would abandon its original budget plan for a $7 fee to see the doctor and unveiled a replacement proposal which included cuts to Medicare rebates for visits of between five and ten minutes duration.

THE Australian Medical Association has stepped up its assault over the Abbott government’s $5 Medicare co-payment, warning of 12-hour queues in hospital emergency departments akin to Britain’s crisis-ridden National Health Service.

Although the government has dumped plans for a mandatory $7 co-payment for Medicare services, it has announced plans to freeze GPs’ rebates until at least 2018 and impose a $5 cut from July 1.

Doctors will be expected to cease bulk-billing and impose an “optional” $5 co-payment to recoup the costs. Children under 16, pensioners, veterans and residents of aged care and nursing home would be exempt.

Doctors fear sick Australians will swamp emergency waiting rooms like they do in the UK, if the federal government doesn't reverse course on its changes to general practice.

And the poor and under-privileged would be hardest hit.

Changes to Medicare, unveiled last month, include a $20 cut to the Medicare rebate for GP Level B consultations lasting less than 10 minutes, from $37.05 to $16.95, which is due to come into effect on January 19.

Britain's National Health Service is in crisis as patients fill emergency departments, causing blow-outs in waiting times and forcing hospitals to cancel operations, call in extra staff and ration access to care, the Australian Medical Association says.

Health and Indigenous Affairs Correspondent

"GPs see more constituents more often than any politician would ever meet those constituents," says former Australian Medical Association president Kerryn Phelps, who owns two GP clinics in Sydney.

"We're seeing patients at least once a year, possibly several times a year."

Professor Phelps says the Abbott government's latest Medicare changes, which include a $20 cut to the rebate for visits of less than 10 minutes, have the potential to make an enemy of a professional group usually thought of as politically conservative.

"GPs are not highly political animals by any means, until you poke the bull ant's nest, and if you do that, they become very political, very quickly, even if they don't realise that's what they're doing," she says.

Already, inside doctors' waiting rooms, patients are being distracted from gossip magazines by posters prepared by the AMA and the Royal College of General Practitioners as part of their campaigns against the changes.

"YOU AND YOUR GP HAVE BEEN TARGETED," warns the poster produced by the RACGP, which shows arrows piercing bullseyes.

National political reporter

The government has capitulated and scrapped its plans to next week cut the Medicare rebate by $20 for short visits to the doctor after a fierce backlash by doctors and non-government Senators, who vowed to veto the measure.

In her first act as the new Health Minister, Sussan Ley broke her holidays to announce on Thursday that the cuts - quietly introduced by her predecessor Peter Dutton late last year - are now "off the table".

Ms Ley said she was still committed to introducing price signals into Medicare including the revised $5 GP co-payment due to start July 1, but pledged to "pause, listen and consult".

"This is very much my stamp, I believe, on the portfolio – that of consulting, engaging and listening," she told reporters in Melbourne.

The Government is responding to concerns that have been raised about the new Medicare measure to improve patient care and tackle the problem of ‘six minute medicine’.

Changes to Level A and B GP consultation items will be taken off the table and will not commence on Monday 19 January.

As the new Health Minister, I am announcing that I will be undertaking wide ranging consultation on the ground with doctors and the community across the country in order to come up with sensible options to deliver appropriate Medicare reforms.

THE Medicare co-payment was, indeed, a hospital pass for incoming Health Minister Sussan Ley. After the initial budget measure hit a brick wall, she was gifted the revised plan to sell to the public, implement around the nation and defend in parliament. Even this early in the new year, all three tasks were looking impossible with strident opposition coming from GPs as the first cuts to doctors’ rebates were due to start next week, and the Senate crossbenchers pledging to undo the measures when parliament returns next month. So the reforms are “off the table” and the government is taking its plans for a Medicare co-payment back to the drawing board. Again.

The idea of ensuring there is a price signal at the point of primary health care is sensible and has been advocated on occasions from both sides of politics. It was a Labor prime minister, Bob Hawke, who first sought to introduce the change. The ALP’s current Shadow Assistant Treasurer, Andrew Leigh, has argued in favour of such a scheme from academe, writing that “free provision leads to over-consumption” in an article more than a decade ago. So the policy objective is not so unpalatable as to be unsaleable. The problem appears to be a familiar one for the Abbott government — mistakes in the policy detail and its public advocacy. We are witnessing yet another messy fumbling of worthwhile reform. Only yesterday Tony Abbott defended the co-payment on radio, describing it as a “difficult decision” that had to be made to make Medicare sustainable. Yet his Health Minister dumped it the next day.

New Health Minister Sussan Ley wants to focus on preventative health when she consults on how to reform Medicare after dumping a controversial GP rebate.

Ms Ley - who late last year replaced Peter Dutton in the job - on Thursday scrapped plans to cut a Medicare rebate for short GP visits, abandoning $1.3 billion in planned savings. Just before Christmas, the government dumped a $7 co-payment measure for GP visits.

She says the government is still committed to a $5 cut to Medicare rebates for general patients from July 1 and a freeze on Medicare rebate indexation through to mid-2018.

Three reports in recent months put the lie to health minister Sussan Ley’s claims that health spending is unsustainable

Friday 16 January 2015 10.34 AEST

Another month, another health minister, another reboot of the discredited GP tax, but the same old false arguments.

Health minister Sussan Ley is sticking like a barnacle to the hull of the discredited and dishonest justification for the GP tax advanced by her failed predecessor, who took one year in the job to be declared Australia’s worst health minister for 40 years.

In her first public appearance this week she repeated Peter Dutton’s claims that because Medicare cost more today than it did 10 years ago, this was proof growth in health funding was “unsustainable”.

Despite Ley being unable to produce any data to support her GP tax arguments on RN’s Breakfast program this morning, there is plenty of data out there. It just says the opposite. Three expert reports from impeccable sources have proved in recent months that the argument health spending is “unsustainable” is garbage.

THE Abbott government’s entire Medicare reform package is up for discussion, including the design of any new co-payment for Medicare services, amid efforts to avert further “war with the medical profession”.

A day after Health Minister Sussan Ley jettisoned a $1.3 billion cut to Medicare rebates for short consultations, she yesterday declared that any new changes would be done in consultation with medical groups.

Ms Ley’s predecessor, Peter Dutton, attracted fierce criticism when he gave the Australian Medical Association less than one hour’s notice before dumping his plan to legislate a $7 co-­payment in favour of a $5 co-­payment through regulation.

Pharmacy Issues:

Community pharmacies may see an increase in the number of patients seeking short consultations, following the expected price increase for a doctor’s visit.

As of January 19 doctors will receive less money from Medicare for patient consultations lasting 10 minutes or less, forcing many GPs to cease bulk-billing, according to The Age.

Previously Medicare paid $37.05 towards such ‘Level B’ visits made by millions of patients for short consultations. The reduction of the GP rebate to $16.95 per visit has left patients to fill the $20.10 price gap.

Nick Logan, a Sydney community pharmacist and owner, believes that the changes will place further financial pressure on people who live on a strict budget, such as pensioners.

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Comment:

I also have to say reading all the articles I still have no idea what is actually going to happen with the Budget at the end of the day.

As pointed out on Insiders a few weeks ago the next chance to have progress in February, 2015 when Parliament comes back! Right now there is a lot of planning going on behind the scenes.